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Treatment of Transvestic Fetishism With Fluoxetine: A Case Report
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Mohammad Amir Usmani, MD * , Rakesh K Gaur, MD*
Suhail Ahmad Azmi, MD* , Sheshank Gangwar, MBBS*
(Received: 1 Nov 2012; Revised: 9 Aug 2012; Accepted: 26 Aug 2012)
Transvestic fetishism is having a sexual or erotic interest in cross-dressing. This case report describes a 17year-old male with transvestic fetishism who suffered from obsessive thoughts and subsequent masturbation as
compulsion. He was managed successfully with fluoxetine.
Declaration of interest: None
Citation: Usmani MA, Gaur RK, Azmi SA, Gangwar Sh. Treatment of transvestic fetishism with fluoxetine:
A case report. Iran J Psychiatry Behav Sci, 2012; 6(2): 100-101.
Keywords:
•Fluoxetine •Paraphilia •Transvestic Fetishism
Introduction1
ransvestic fetishism is having a
sexual or erotic interest in crossdressing. It differs from crossdressing for entertainment or other
purposes that do not involve sexual
arousal and is categorized as a paraphilia in
the Diagnostic and Statistical Manual of the
American Psychiatric Association. There are
two key criteria before a psychiatric diagnosis
of "transvestic fetishism" is made(1):recurrent,
intense sexually arousing fantasies, urges, or
behavior,
involving
cross-dressing.This
causes clinically significant distress or
impairment, whether socially, at work, or
elsewhere.
T
Case report
A 17-year-old Indian male presented to the
psychiatry outpatient department with the
complaint of having recurrent desires to wear
the clothes of his mother. The thought was
very distressing to the patient andcame to his
mind again and again until he wore those
Authors’ affiliation: *Department of Psychiatry, J.N. Medical
College, A.M.U. Aligarh, U.P., INDIA.
 Corresponding author: Mohammad Amir Usmani MD, Senior
Resident, Department of Psychiatry, J.N. Medical College, A.M.U.
Aligarh, U.P.,INDIA, 202002.
Tel: +919897763522
Fax: +1942481166
E mail- [email protected]
clothes and masturbated in it. For this
purpose, he stole a complete set of his
mother’s clothes. He has been wearing the
clothes secretly for the past 2 years solely for
the purpose of pleasure. Recently he was
caught by the parents while wearing the
clothes and masturbating and then beaten by
the parents. On further enquiry he admitted
that the thought is obsessive in nature, he tries
to control it but is not able to do so. He added
that he experiences restlessness until he wears
the clothes and masturbates in order to
overcome the anxiety. The thought caused
significant impairment in his studies and other
social functioning. He did not have any desire
to be treated as female nor did he have any
preoccupations regarding hormonal or
surgical
treatment
for
sex
change
therapy.There was a past history of homosexual activity but upon presentation he
denied having any sexual relationship. His
general
physical
and
neurological
examinations were within normal limits. On
investigations, contrast-enhanced CT scan of
the brain and electroencephalograph were also
found to be normal.
He was diagnosed provisionally as a case
of transvestic fetishism and fluoxetine (20 mg
once a day) was prescribed. The dose of
fluoxetine was increased to 40 mg once a day
after two weeks. The patient was followed for
the next 6 weeks. He showed significant
Iran J Psychiatry Behav Sci, Volume 6, Number2, Autumn / Winter 2012
100
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Fluoxetine and Transvestic fetishism
improvement with adecrease in recurrent
thoughts and urge to masturbate.
editing the manuscript. All authors read and
approved the final manuscript.
Discussion
The case described above was not having
the desire to be treated as female. He was not
preoccupied with any thought of sex change.
The problem which he suffered was obsessive
thoughts of wearing female clothes and
subsequent compulsive masturbation. The
psychopathology leads to the obsessive
spectrum of the disease rather than gender
identity disorder. However, transsexualism
and erotic arousal to cross-dressing are not
mutually exclusive (2).
There is no established drug for treatment
of transvestic fetishism. Stein et al. described
paraphilias as a neurologiacal spectrum
disorder and considered obsession and
compulsion at the compulsive end and
paraphilias at the impulsive end of the
spectrum. He also discussed the use of
serotonergic medications for the treatment of
sexual obsessions (3). Fedoroff reported
successful treatment of transvestic fetishism
with buspirone(4). Jogerson also reported
successful treatment of cross dressing with
fluoxetine(5).Use of sertraline and lithium (6)
as well as escitalopram(7)has also been
reported for this disorder. Abdo et al. have
reported two cases in which transvestism and
obsessive-compulsive disorder (OCD) were
related and suggested that the case with more
ego dystonic thoughts was more responsive to
treatment(8).
The case report highlights the possible
association of paraphilias and obsession.
Administration of fluoxetine would be useful
for management of an OCD-transvestism
continuum disorder.
References
1. American Psychiatric Association.
Diagnostic and Statistical Manual of Mental
Disorders (4th ed., text rev.). Washington,
DC:2000.
2.Blanchard R. The DSM Diagnostic
Criteria for Transvestic Fetishism. Arch Sex
Behav 2010; 39(2):363-72.
3. Stein DJ, Hollander E, Anthony DT,
Schneier FR, Fallon BA, Liebowitz MR, et al.
Serotonergic
medications
for
sexual
obsessions, sexual addictions, and paraphilias.
J Clin Psychiatry 1992; 53(8):267-71.
4.Fedoroff JP. Buspirone hydrochloride in
the treatment of transvestic fetishism. J Clin
Psychiatry 1988; 49(10):408-9.
5.
Jorgensen
VT.
Cross-dressing
successfully treated with fluoxetine. NY State
J Med 1990; 90(11):566-7.
6. Rubenstein EB, Engel NL.Successful
treatment of transvestic fetishism with
sertraline and lithium. J Clin Psychiatry 1996;
57(2):92.
7. Praharaj SK. Escitalopram treatment of
transvestic fetishism: A case report. Ger J
Psychiatry 2004; 7(2): 20-1.
8.Abdo CH, Hounie A, de Tubino Scanavino
M, Miguel EC. OCD and transvestism: is there
a relationship? Acta Psychiatr Scand 2001;
103(6):471-3.
Authors’ Contributions
MAU designed the evaluation and drafted
the manuscript. RKG and SAA reevaluated
the diagnosis and revised the manuscript. ShG
helped in acquisition of clinical data and
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Iran J Psychiatry Behav Sci, Volume 6, Number2, Autumn / Winter 2012